A portable system for warm perfusion of donor lungs during transport yields good outcomes for high-risk recipients, first-in-man results suggested.

Action Points

Explain that a pilot first-in-man study of a portable device for warm perfusion of donor lungs on the way to transplantation showed that the technique was successful in the 12 patients receiving the transplants.

Note that the study was not a randomized controlled trial assessing this technique against current cold flush and cold static storage methods.

A portable system for warm perfusion of donor lungs during transport yields good outcomes for high-risk recipients, first-in-man results suggested.

All 12 patients who got lungs preserved with the novel system survived the transplant without graft failure at 30 days, Gregor Warnecke, MD, of Hanover Medical School in Hanover, Germany, and colleagues found.

Lung function appeared to be as good at the final assessment as before organ harvest, the group reported online in The Lancet.

The hope is that warm perfusion and lung recruitment in the device will prove to boost outcomes by preventing deterioration and even improving the quality of marginal organs, although that has yet to be proven in a controlled trial.

Currently, about 80% of donor lungs can't be used because of the lung damage sustained by edema after brain death, pulmonary complications common in the ICU, and other problems.

The standard of care for preservation of donated lungs -- a cold flush and static cold storage -- is reasonably good as long as ischemia times aren't excessive and the organs are of good quality to start with, Warnecke's group noted.

Several strategies are under development to expand the pool of viable lungs by improving handling techniques.

The Organ Care System Lung device used in the study provides warm perfusion and lung recruitment with constant lung function monitoring from the donor site to the transplant site.

"Development of ex-vivo lung perfusion could affect several aspects of transplantation in coming years and be one of the most important advances of the past two decades," José M. Borro, MD, of the University Hospital A Coruña, Spain, argued in an accompanying commentary.

"The extension of preservation time will allow immunological compatibility tests and the appropriate assessments of organ function to be done and enable organs to be obtained from distant locations."

However, he suggested caution in interpreting the study results because of the lack of a control group and differences in methods at the two centers involved in the study (lung retrieval from the device wasn't the same).

The results are promising but shouldn't get hopes up too much until confirmed in the prospective, randomized INSPIRE trial now underway with the device, Borro concluded.

The pilot study included all donor lungs without air leakage from lung injury that were offered to two centers in Europe and the 12 high-risk patients who received them. Six were considered extended criteria donations because of factors like cardiac death, older age, or impaired oxygenation capacity.

The lungs were perfused with a low-potassium dextran solution, then explanted and immediately hooked up to the portable device for transportation to the transplant center. Perfusion in the device was done at body temperature with Steen's solution, two red blood cell concentrates, multivitamins, glucose, and other compounds along with ventilation to simulate breathing.

Transplant was done after a mean of around 5 hours on the machine plus 134 minutes of cumulative cold ischemia time for the first lung and 249 for the second lung around harvest and implant.

The mean ratio of partial pressure of oxygen to fractional concentration of oxygen in inspired air (PaO2 to FIO2) didn't differ from preharvest in the donor to the final measurement before transplantation (P=0.72). In several cases, the ratio actually improved, which Warknecke's group pointed to as fitting with the concept of reconditioning lungs.

After transplantation, none of the patients needed extracorporeal mechanical oxygenation (ECMO) due to primary graft dysfunction.

All 12 patients were off ECMO and mechanical ventilation by 30 days without any redo transplants.

One patient died 140 days later from cardiomyopathy with a final forced expiratory volume in 1 minute (FEV1) at 62% of predicted and forced vital capacity at 55% of predicted at the last measurement.

Mean best FEV1 in the group in the first year post-transplant was 87%.

In other words, "all patients were discharged from hospital with good lung function after transplantation," the researchers concluded. "Midterm outcomes are encouraging, and spirometry data suggest that patients are in good functional states -- ie, lungs are healthy and functioning well."

The study was supported by TransMedics and a grant from the German Federal Ministry of Education and Research.